Active NPI
Eliza Burwell Cheitlin
- Physician Assistant
- Vancouver, WA
National Provider Identifier
1629633557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA61133066
- Practice address
- 210 SE 136TH Ave
Vancouver, WA 98684-6930 - Phone
- (360) 944-9889
- NPI assigned
- May 6, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | PA61133066 | WA | Primary |
Addresses
Primary practice location
210 SE 136TH Ave
Vancouver, WA 98684-6930
Mailing address
1498 SE Tech Center PL Ste 240
Vancouver, WA 98683-5508
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210413002818 | WA | Practitioner - Physician Assistant | 0345658233 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northwest Cancer Specialists PC
Practice addresses (Care Compare)
210 SE 136TH Ave
Vancouver, WA 98684-6930
Phone (360) 944-9889
Hospital & facility affiliations
- Peacehealth Southwest Medical Cente
- Legacy Salmon Creek Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA61133066 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Cancer Specialists PC | Current | Accepting new patients | |
| Northwest Cancer Specialists PC | Current | Accepting new patients |
Locations
210 SE 136th Ave
Vancouver, WA 98684
Phone (360) 944-9889
1498 SE Tech Center Pl
Ste 240
Vancouver, WA 98683
Phone (360) 597-1309
Interoperability endpoints
- eliza.cheitlin@compass.ikm.direct-ci.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialty Pharmacy
- Vancouver, WA
- NPI 1770939019
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617667200000",
"number": "1629633557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1498 SE TECH CENTER PL STE 240",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986835508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 SE 136TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986846930",
"telephone_number": "360-944-9889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHEITLIN",
"first_name": "ELIZA",
"middle_name": "BURWELL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-06",
"last_updated": "2021-04-06",
"certification_date": "2021-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA61133066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.